Provider Demographics
NPI:1942668223
Name:RANA AZZO, DDS, PLLC
Entity Type:Organization
Organization Name:RANA AZZO, DDS, PLLC
Other - Org Name:ELITE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANA
Authorized Official - Middle Name:ADNAN-HANNA
Authorized Official - Last Name:AZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-974-7405
Mailing Address - Street 1:2141 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4807
Mailing Address - Country:US
Mailing Address - Phone:586-330-1800
Mailing Address - Fax:
Practice Address - Street 1:2141 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4807
Practice Address - Country:US
Practice Address - Phone:586-330-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020537261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental